Veterans Health Administration, Department of Veterans Affairs.
In compliance with the Paperwork Reduction Act (PRA) of 1995 (44 U.S.C. 3501-21), this notice announces that the Veterans Health Administration (VHA), Department of Veterans Affairs, has submitted the collection of information abstracted below to the Office of Management and Budget (OMB) for review and comment. The PRA submission describes the nature of the information collection and its expected cost and burden and includes the actual data collection instrument.
Comments must be submitted on or before October 21, 2005.Start Further Info
FOR FURTHER INFORMATION OR A COPY OF THE SUBMISSION CONTACT:
Denise McLamb, Records Management Service (005E3), Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420, (202) 273-8030, FAX (202) 273-5981 or e-mail to: firstname.lastname@example.org. Please refer to “OMB Control No. 2900-0556.”
Send comments and recommendations concerning any aspect of the information collection to VA's OMB Desk Officer, OMB Human Resources and Housing Branch, New Executive Office Building, Room 10235, Washington, DC 20503, (202) 395-7316. Please refer to “OMB Control No. 2900-0556” in any correspondence.End Further Info End Preamble Start Supplemental Information
Title: VA Advance Directive: Living Will and Durable Power of Attorney for Health Care, VA Form 10-0137.
OMB Control Number: 2900-0556.
Type of Review: Extension of a currently approved collection.
Abstract: Claimants admitted to a VA medical facility complete VA Form 10-0137 to appoint a health care agent to Start Printed Page 55454make decision about his or her medical treat and to record specific instructions about their treatment preferences in the event they no longer can express their preferred treatment. VA's health care professionals use the data to carry out the claimant's wish.
An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. The Federal Register Notice with a 60-day comment period soliciting comments on this collection of information was published on April 29, 2005, at pages 22391-22392.
Affected Public: Individuals or Households.
Estimated Total Annual Burden: 128,127 hours.
Estimated Average Burden Per Respondent: 30 minutes.
Frequency of Response: One time.
Estimated Number of Respondents: 256,253.Start Signature
Dated: September 9, 2005.
By direction of the Secretary.
Program Analyst, Records Management Service.
[FR Doc. 05-18874 Filed 9-20-05; 8:45 am]
BILLING CODE 8320-01-P